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General NPI Number Information
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NPI Number | 1225520638
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Entity Type | Organization
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Legal Business Name | ECCLESIA COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 10306 N 138TH EAST AVE STE 200
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City | OWASSO
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State | OK
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Zip | 74055-4665
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Country | US
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Telephone | 918-671-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 8324 N QUEBEC AVE
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City | SPERRY
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State | OK
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Zip | 74073-4741
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Country | US
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Telephone | 918-671-7764
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Fax |
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Authorized Official
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Title or Position | OWNER AND LPC
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Name | PERCY CALVERT III
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Credential | LPC
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Telephone | 918-671-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6365
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License Number State | OK
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